Students reflect on overconsumption

Looking at the number of students jogging down Campus Drive during the day, it is hard to imagine that many of those same health-conscious people will be downing toxic amounts of alcoholic beverages come Friday and Saturday night.

To date, over 50 Duke students have been taken to the Emergency Department for alcohol poisoning this school year. On rare occasions, that experience may include getting their stomachs pumped; for most, only a supervised stay in the infirmary. But for nearly all students who end up in the hospital, the experience is life-changing.

"I thought I came to college a responsible drinker," said one freshman who was taken to the hospital only a month into her college career. "I had never thrown up before.... I thought I had an iron stomach.... But everyone has limits-I guess I just had never reached mine."

It was a Saturday night around 11 p.m. when this freshman received a phone call from friends. Although she had not planned to go out, she found herself on West Campus 30 minutes later playing "catch-up" with two vodka drinks.

At least that's what she recalls. Her friends, however, say that within the next hour, she consumed several more drinks made with Everclear-95 percent pure grain alcohol-bringing her blood alcohol level to .376. That's what she and her friends found out when the paramedics arrived.

Justin Odegard, director of Duke's student-led Emergency Medical Services unit, said that when a distress call comes in, an EMS technician is usually on the way in about one minute.

Odegard remembers one incident from earlier this year particularly clearly: "As I ran up the dorm's stairs, I ran through a quick mental check-list of priorities: first airway, then level of consciousness, rapid trauma assessment," the junior said. "After reaching the designated floor, a police officer waved me into a bathroom, where I found the patient slumped on the floor, completely unresponsive to the best efforts of her friends to sit her up."

Odegard's initial assessment: Multiple abrasions indicated some type of fall, but more importantly, the student's breath was insufficient to fill her lungs-her own vomit was constricting the airway. His first priority was to clear the airway, then protect it using a type of plastic tube.

"After I woke up, I asked for my friends repeatedly, but the nurses never got them," she said. "My friends said they finally left at 5:45 a.m., and I never got to see them. It was awful to wake up and not have anyone with me."

Along with the typical hospital gown, the freshman also had IVs in her arms, electrodes on her body, and heart, oxygen and brain monitors at her side.

Dr. Kathleen Clem, chief of emergency medicine at Duke Hospital, said nearly all patients sent to the emergency room for drinking are hooked up to such equipment in the event of complications.

"If the patient is not responding, we definitely put them on heart and oxygen desaturation monitors," she said. "It's a small percentage [who will have problems], but it is worth it."

Clem said that a ventilator is likely to have saved at least one life this year. That student's monitor and physical examination showed that his oxygen levels had decreased to the point that permanent brain damage or death could occur.

Intravenous lines are another necessary precaution. Initially carrying only saline, they are fitted to the students so that if chemical intervention is needed later, doctors can use the prepared IV for emergency measures.

Altogether, emergency alcohol care, including ambulance ride, hospital bed, medicine, around-the-clock supervision and the infirmary stay the next day costs a student about $1,000-more if there are complications.

But for many students, the financial costs are substantially less than the emotional impact of the experience.

"For the next week, I was walking around sad," said one student. "I was thinking, `Holy s--t, what did I do to myself?' I became very introspective.... I felt so vulnerable."

Others say they felt ashamed.

"It kind of makes you feel like you've lost control," one female freshman said. "Like you don't know what you are doing."

For another student, the experience was so traumatic that she felt compelled to tell her parents, even though they did not know that she drank. "I figured my parents should know," she said. "It was a big event in my life-I felt my whole world had fallen apart in about a week."

But for yet another freshman, talking to her parents wasn't as easy. "They found out," she said. "I checked the option to redirect the bill [to my campus address, rather than my home address], but it didn't happen.... I knew I would tell them eventually, but only when I was ready."

In these cases, everything worked out well, including the mandatory visit with Assistant Dean of Student Development Stephen Bryan and a one-hour session at Counseling and Psychological Services or the Duke Addictions Program.

"I told [Bryan] how badly I felt about the situation.... I felt so ashamed," said one of the freshmen. "He actually told me to stop beating myself up about it."

At the counseling session, students speak with a counselor to assess their levels of alcohol use and discuss the particular incidents that led them to the emergency room. The hope is that the counselor can help the students evaluate their choices about alcohol and start making decisions that keep them safe.

"I basically think that [the counselor] told me stuff I already knew," one student said. "Everyone knows the risks associated with drinking-there is no way someone could be ignorant of it. It is more a matter of making your own choices."

But people in Duke counseling services are afraid that deeper psychological problems could be impacting some students' drinking choices.

"There may be some students who made a decision to drink when, in fact, they ended up getting drunk and it was not their typical way," said Libby Webb, a clinical social worker and CAPS interim co-director. "At worst, [the mandatory session] could feel as if it was a waste of an hour. But I think that there are many reasons why we use alcohol in our life that can sometimes be helpful to tease out."

Students agreed that the mandatory CAPS session was a good idea-if only to serve as a check for those whose drinking experiences could be indicative of problems worse than not knowing their limits.

Webb added that for many Duke students, alcohol abuse coincides with high levels of stress. "Sometimes those factors working together can lead to a night that no one had planned for," she said.

Certainly, a night in the ER is something no Duke student wants to consider.

"You're in a room with all your friends and everyone is having a ball... and then at some point you realize that you've had six shots in an hour," said a female student. "I was going out to drink and perhaps to get drunk..., but I did plan to make it back out the door that night."